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Minimally Invasive Lumbar Spinal Fusion Is More Effective Than Open Fusion: A Meta-Analysis
박융,석상옥,이수빈,하중원 연세대학교의과대학 2018 Yonsei medical journal Vol.59 No.4
Purpose: To evaluate the efficacy of minimally invasive spinal fusion in comparison to open fusion for adult lumbar spondylolisthesisor spondylosis. Materials and Methods: The present study was conducted as a meta-analysis of all estimates from studies that were selected aftercomprehensive literature search by two independent reviewers. Results: Of 745 articles, nine prospective cohort studies were identified. The quality of evidence was downgraded because ofstudy design, inconsistency, imprecision, and publication bias. Greater Oswestry Disability Index score improvement [weightedmean difference (WMD), 3.2; 95% confidence interval (CI), 1.5 to 5.0; p=0.0003] and a lower infection rate (odds ratio, 0.3; 95% CI,0.1 to 0.9; p=0.02) were observed in the minimally invasive group (low-quality evidence). The minimally invasive group had lessblood loss (WMD, 269.5 mL; 95% CI, 246.2 to 292.9 mL; p<0.0001), a shorter hospital stay (WMD, 1.3 days; 95% CI, 1.1 to 1.5 days,p<0.0001), and longer operation time (WMD, 21.0 minutes; 95% CI, 15.9 to 26.2 minutes; p<0.0001) and radiation exposure time(WMD, 25.4 seconds; 95% CI, 22.0 to 28.8 seconds, p<0.0001) than the open group (low-quality evidence). There were no significantdifferences in pain improvement, fusion rate, complications, or subsequent surgeries between the two treatment groups (lowqualityevidence). Conclusion: Although present findings are limited by insufficient evidence and there is a lack of adequately powered high-qualityrandomized controlled trials to address this gap in evidence, our results support that minimally invasive lumbar fusion is moreeffective than open fusion for adult spondylolisthesis and other spondylosis in terms of functional improvement, reducing infectionrate, and decreasing blood loss and hospital stay.
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박영,이수빈,석상옥,조병우,하중원 대한정형외과학회 2015 Clinics in Orthopedic Surgery Vol.7 No.1
Background: As surgical complications tend to occur more frequently in the beginning stages of a surgeon’s career, knowledge ofperioperative complications is important to perform a safe procedure, especially if the surgeon is a novice. We sought to identifyand describe perioperative complications and their management in connection with minimally invasive transforaminal lumbar interbodyfusion (TLIF). Methods: We performed a retrospective chart review of our first 124 patients who underwent minimally invasive TLIF. The primaryoutcome measure was adverse events during the perioperative period, including neurovascular injury, implant-related complications,and wound infection. Pseudarthroses and adjacent segment pathologies were not included in this review. Adverse eventsthat were not specifically related to spinal surgery and did not affect recovery were also excluded. Results: Perioperative complications occurred in 9% of patients (11/124); including three cases of temporary postoperative neuralgia,two deep wound infections, two pedicle screw misplacements, two cage migrations, one dural tear, and one grafted boneextrusion. No neurologic deficits were reported. Eight complications occurred in the first one-third of the series and only 3 complicationsoccurred in the last two-thirds of the series. Additional surgeries were performed in 6% of patients (7/124); including fourreoperations (two for cage migrations, one for a misplaced screw, and one for an extruded graft bone fragment) and three hardwareremovals (one for a misplaced screw and two for infected cages). Conclusions: We found perioperative complications occurred more often in the early period of a surgeon's experience with minimallyinvasive TLIF. Implant-related complications were common and successfully managed by additional surgeries in this series. We suggest greater caution should be exercised to avoid the potential complications, especially when surgeon is a novice to thisprocedure.
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